So what is advanced practice

This question raises a number of issues. Having looked at the literature there still appears to be confusion about what 'advanced practice' is.Advanced practice is not about the acquisition of skills that doctors would normally have. It is important to differentiate advanced clinical skills from advanced nursing practice, as they are not one and the same and they cannot be used interchangeably. That is not to say that a number of nurse practitioners are not also advanced practice nurses; but by mixing the two we are in danger of losing the essence of nursing by placing value on non-nursing activities.

Historically, nurse practitioners have been advanced practice nurses. This is because the posts have been about changing traditional boundaries and challenging the status quo. Therefore the people who took these posts would have to have been advanced practice nurses. However, now, further down the line, these roles are established and commonplace, so that they don't necessarily require the same skills from the post-holder. Again, this is not to say that all post-holders are not as capable as before; just that the requirements to work successfully in these posts are now different. Because of this it is important to say that the registration of advanced nurse practitioners is an important and significant step, which is generally well supported. However, advanced practice is more than that: as Le-Mon (2000) suggested, it is a pinnacle of nursing that is more than merely a collection of extended roles.

It is also important to remember that most advanced clinical roles globally have evolved from a shortage of doctors. In some countries like Canada (de Leon-Demare et al., 1999), when that shortage is reversed there is a huge backlash against these roles. Therefore it is important to co-develop advanced practice roles that don't place overmuch value on the acquisition of medical skills such as physical assessment, and to utilise existing models such as the Nordic experience (Lorensen et al., 1998), which consists purely of 'higher-level' nursing skills and knowledge based on nursing research that improves nursing care for patients, and not nursing theory, which is often perceived by nurses as being abstract and unrelated to practice.